Decreased bone mineral density in young adults treated with SCT in childhood: the role of 25-hydroxyvitamin D

Abstract

We measured bone mineral density (BMD) with dualenergy X-ray absorptiometry in the total body, at the lumbar spine, at the femoral neck and in the total hip, in 18 young adults with a median of 18.2 years after SCT. Fifteen patients had undergone auto-SCT and all patients had received TBI. The patients had significantly lower BMD in the total body, at the femoral neck, and in the total hip compared with age-and sex-matched controls. Six of 18 patients (33%) had low bone mass (z-score oÀ1) at one or more measurement sites, as opposed to two of the controls (11%, P ¼ 0.29). We found no significant influence of growth hormone levels or of untreated hypogonadism on BMD variables. Levels of 25-hydroxy (25(OH)) vitamin D were lower among the patients (35.2 vs 48.8 nmol/L, P ¼ 0.044) and were significantly correlated with total body BMD in the patient group (r ¼ 0.55, P ¼ 0.021). All six patients with low bone mass had hypovitaminosis D (p37 nmol/L as opposed to 4 of the 11 (36%) patients without low bone mass (P ¼ 0.035). In conclusion, we found decreased BMD in SCT survivors, which may in part be caused by 25(OH) vitamin D deficiency.

Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients

“…Children diagnosed with solid tumors had a higher prevalence of 25(OH)D deficiency (median 61.5%) and insufficiency (median 71%) than those children diagnosed with other type of malignancies, consistent with one large study (n ¼ 2198) of adult oncology patients, which reported a prevalence of 25(OH)D deficiency of 75% [42]. Nevertheless, a few cautionary notes should be mentioned; the small number of studies looking at this population [24,26,36] and their small sample sizes, the seasonality from different studies (often not reported), the different assay methods used to identify 25(OH)D status and the lack of information on intra-assay coefficient of variation, which does not allow us to estimate the validity and reliability of the 25(OH)D results [40]. Additionally, the geographical differences in the prevalence of 25(OH)D levels as well as the discrepancy seen in the representation of childhood diagnosis (Fig.…”

“…In the USA fortification is discretionary [43,44], whilst in Canada fortification of milk, margarine and plant-based milk is mandatory [44]. An important observation is the difference in the prevalence of vitamin D inadequacy in both Europe and North America between studies from the 1980s and 1990s [23,27,28,31,35] and those published after 2000 [9,24,29,36,38]; with most studies published after 2000 reporting higher prevalence of 25(OH)D than those published before. This could be a reflection of either an increase in 25(OH)D inadequacy in the pediatric oncology population, also seen in the general pediatric population [2,13], or as previously suggested [40], the new more specific assay methods, which are more sensitive to vitamin D metabolites, thus providing more accurate results.…”

“…The methods used to analyze vitamin D status were reported in all studies, however only five studies [22,30,32,36,38] reported intra assays' coefficient of variation, which ranged from 3.6 to 14% (Table 1).…”

Self‐reported quality of life in long‐term survivors of childhood lymphoblastic malignancy treated with hematopoietic stem cell transplantation versus conventional therapy

“…From studies performed at our center on the same individuals in the present SCT group, as well as large studies from other centers, it is abundantly clear that morbidity is very high after SCT, including late endocrinological complications such as growth impairment, growth hormone deficiency, thyroid and sex hormone deficiencies, and infertility . A high prevalence of impaired glucose metabolism, adverse body composition, and other cardiometabolic traits have emerged as novel late complications . Non‐endocrinological complications of SCT that also compromise self‐appreciation of physical roles and limit physical participation are pulmonary and cardiac function abnormalities, cataracts, and skeletal changes such as avascular necrosis, exostoses, and osteoporosis .…”

Bone loss and vitamin D deficiency in children undergoing hematopoietic cell transplantation

“…Several studies have described bone loss in survivors of pediatric HCT [1,2,4,[20][21][22]. Greater bone loss has been observed in children treated with HCT compared to chemotherapy alone [4].…”